Carcinoma of the breast: analysis of total lymph node involvement versus level of metastasis.

The histologic presence of axillary lymph node metastasis is the most commonly used indicator or prognosis for patients with operable breast cancer. The record of 385 patients treated by 380 radical mastectomies between the years 1944 and 1972 were reviewed to clarify this. The axillary nodes recovered were evenly distributed. The median number of positive lymph nodes at each level was two; 50% had involvement of only one level. The number of lymph nodes identified increased with the number of positive nodes. When compared with similar patients, survival curves for those having a single involved node and also those having multiple metastatic nodes were similar whether the node were in the proximal, middle, or distal levels. The 10-year determinate survival for patients with fewer than five positive positive nodes was just under 50%. High positive nodal counts, or involvement of more than one level, were associated with local recurrence of disease.